1782. Antimicrobial Stewardship Opportunities in Gram-Negative Bacteremia Treatment at a Community Teaching Hospital

BACKGROUND: Gram Negative Bacteremia (GNB) is frequently encountered among hospitalized patients. In contrast to traditional 14-day lengths of treatment (LOT), recent literature supports a shorter (7-day) LOT for uncomplicated GNB with adequate source control, and the effectiveness of oral antibiotics. The goal of the following is to outline current practices of GNB treatment and identify opportunities for antibiotic stewardship (AS). METHODS: This study retrospectively reviewed all cases of uncomplicated GNB at a 528-bed community teaching hospital in Rochester, NY from January 2021 through March 2022. Demographic, laboratory, microbiologic, antibiotic therapy data, results of follow-up blood cultures (FUBC), hospital length of stay and 30-day readmission were collected. Exclusions were complicated or polymicrobial bacteremia, deaths during treatment, or prolonged hospitalization due to other medical factors. Influences of Infectious diseases (ID) or AS consult on treatment and outcomes were compared to cases with no consult. Continuous variables were analyzed using unpaired t-tests; categorical variables were analyzed using Fischer’s exact test and Chi-square as appropriate. RESULTS: 133 cases met inclusion criteria. Demographic and laboratory data are in Table 1. The frequency of bacteria isolated and source of infection are in Figure 1 and Figure 2. ID was significantly more often consulted for central line infections (17% vs 3%, p=0.01), and significantly less frequently involved in urinary tract infections (39% vs 69%, p=0.009). While total LOT were similarly longer than current literature supports (11.7 vs 12.5 days, p=0.2644), cases without ID consultation received significantly more days of oral treatment (4.7 vs 7.1 days, p=0.0275). There were no significant differences between receipt and no receipt of AS recommendations. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: GNB continued to receive longer LOTs than current literature recommends, with longer IV durations recommended by ID consultants compared to those without ID consult. Educational initiatives regarding the safety of shorter LOT for GNB, including the efficacy of oral antibiotics, are needed and should include ID specialists. DISCLOSURES: All Authors: No reported disclosures

Antimicrobial Stewardship Opportunities in Hospitalized Patients with Febrile Neutropenia

Objectives: To discuss the delicate balance between risks and benefits of antibiotic use in the management of FN. To review the growing evidence for antimicrobial stewardship in cancer populations. To highlight potential stewardship opportunities in common clinical scenarios in patients with FN

Which Antibiotic are You? Evaluation of a Global Antibiotic Awareness Personality Quiz

Background Improving understanding of the impact of antibiotic overuse is a key component of the global action plan to address antibiotic resistance. Play is an underutilized opportunity to engage adults in learning about antibiotic resistance and the importance of appropriate antibiotic use in mitigating this public health threat. Our objective was to evaluate the reach of a web-based antibiotic awareness personality quiz. Figure 1. Antibiotic Personality Quiz Participants Methods A personality quiz (http://www.tiny.cc/antibioticquiz) was developed using an online platform (Tryinteract.com). The quiz included a series of short personality-based questions. Once complete, based on the responses provided, the respondent was automatically assigned an antibiotic that best matched their personality. This result was accompanied by key teaching points about the assigned antibiotic, a statement about the importance of appropriate antibiotic use and links to find more information. The quiz was launched in November 2017 to coincide with World Antibiotic Awareness Week and disseminated via social media. It was updated iteratively each year. We evaluated usage statistics from November 7 2017 to June 7 2020. Results During the 31-month evaluation period, there were 287,868 views of the quiz, and it was completed 207,148 times. The quiz was shared extensively on social media (Facebook 1667 shares, Twitter 1390 clicks). From a subset of 37,825 recent participants who were asked about their profession, most identified as non-infectious diseases healthcare professionals (n= 18,235, 48.2%), followed by infectious disease healthcare professionals (n=8,119, 21.8%), and healthcare students (n=6,986, 18.5%) (Figure 1). Respondents were well-represented globally, including US, Canada, Spain, France, India, United Kingdom, and Indonesia. Conclusion This exploratory analysis suggests incorporation of play into social media campaigns may augment the size of the receiving audience. An antibiotic awareness personality quiz engaged a high volume and broad range of non-infectious disease experts in learning more about antibiotic resistance. Antimicrobial stewards and public health campaign leaders should incorporate play into awareness opportunities and evaluate their impact

1789. Current Antibiotic Prescription Practices in Hospitalized Patients with Acute Myeloid Leukemia (AML) and Febrile Neutropenia of Unknown Origin (FN-FUO): Data from a Large Tertiary Community Hospital

BACKGROUND: Optimal duration of empiric antibiotic therapy in hospitalized patients with febrile neutropenia of unknown origin (FN-FUO) remains controversial. Emerging evidence suggests that early discontinuation of antibiotics at 48-72 hours of apyrexia is safe regardless of neutrophil count. However, in the U.S., the adoption of this and other antibiotic use practices in these patients remains unstandardized and understudied, particularly in community hospitals. In this pilot study, we sought to evaluate current antibiotic prescription practices in our large community hospital in admitted patients with AML and FN-FUO. METHODS: We conducted a retrospective cohort study from January 1st, 2020 to December 16(th), 2021. All patients admitted with a diagnosis of AML and febrile neutropenia (FN) were screened and those with FN-FUO, defined as no microbiological growth on blood, respiratory or urine cultures at 48 hours of first fever were included. Data on initial antibiotic choices, use of vancomycin and its congruence with IDSA guidelines, mean days of therapy (DOT), mean days of “excess” therapy (DOET), defined by days of antibiotics after >72 hours of apyrexia and total DOET were obtained by medical record review and descriptive analysis was performed. RESULTS: A total of 65 patients with FN were screened. After screening, 27 patients met criteria for inclusion and data from their hospital stay was obtained (Table 1). Cefepime was the preferred choice of initial intravenous β-lactam in 85% of cases and piperacillin-tazobactam was used in the remainder of cases. Vancomycin was used initially in 55% of cases out of which its use was considered to be incongruent with IDSA guidelines in 25% of cases. The most common reason for IDSA incongruent use of vancomycin was lack of documentation for its use. Mean DOT was 10 and mean DOET was 3 (Table 2). In total, we identified 87 excess days of antibiotic therapy in this cohort. [Figure: see text] [Figure: see text] CONCLUSION: Little is known about antibiotic prescription practices in high risk FN-FUO patients in community hospitals. Our findings highlight potential concrete antibiotic stewardship targets and shortening this knowledge gap may help guide the development of interventions that have been previously shown to improve clinical outcomes in this overall underrepresented population. DISCLOSURES: All Authors: No reported disclosures

Review of Clinical Outcomes in Patients Treated with Beta-lactam vs Non-beta-lactam Therapy for AmpC Producing Bacterial Bloodstream Infections

Background AmpC beta-lactamase producing organisms are traditionally treated with carbapenem or fluoroquinolone antibiotics. Recent studies, however, describe similar clinical outcomes in patients that receive cefepime or piperacillin/tazobactam. We sought to assess outcomes in patients with bloodstream infections caused by AmpC-producing organisms that received beta-lactams compared non-beta-lactam therapy. Methods Data was obtained retrospectively from the electronic health record (EHR) from January 2012 to February 2020. The primary objective was 30-day mortality from the day of first positive blood cultures with Enterobacter spp., Citrobacter spp., or Serratia spp. in patients who received non-beta-lactam therapy (carbapenem, fluoroquinolone, trimethoprim/sulfamethoxazole) to those who received beta-lactam therapy (cefepime, piperacillin/tazobactam). Secondary objectives included 30-day recurrence of bacteremia, pathogen isolated, source of bacteremia, hospital length of stay, and duration of antimicrobial therapy. Results A total of 90 patients were included, 50 in the non-beta lactam group and 40 in the beta-lactam group. Demographics were similar between groups. Thirty-day mortality was significantly higher in the beta-lactam group (20% vs 2%, p=0.009). Enterobacter spp. was the most frequently identified pathogen (67%), most commonly isolated from a urinary (31%) or intra-abdominal source (22%). The average duration of antibiotic therapy was significantly higher in the non-beta lactam group (18 vs 12 days, p=0.001). In contrast, there was no significant difference found in hospital length of stay, recurrence of bacteremia, pathogen isolated or source of bacteremia between groups. Conclusion Beta-lactam therapy for the treatment of bloodstream infections caused by Amp-C producing organisms was associated with significantly greater 30-day mortality compared to patients that received non-beta-lactam therapy

Antimicrobial Efficacy

This annual review is intended to be a reference to describe the potential in vivo activity of various antimicrobial agents when the identity of the infecting organism is known. Because the early initiation of appropriate therapy has been noted to improve clinical outcomes in patients with serious infections, empiric therapy frequently demands the use of a broad-spectrum antimicrobial agent until the specific infecting bacteria have been identified

Benign recurrent aseptic meningitis (Mollaret’s meningitis) in an elderly male: A case report

Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviral due to negative cerebrospinal fluid analysis, culture and multiplex polymerase chain reaction

Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

OBJECTIVE: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). DESIGN AND SETTING: An ambidirectional observation in a 528-bed teaching hospital. PATIENTS: All inpatients from July 1, 2012, to February 1, 2021. METHODS: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2-3 FTE), below recommended IP levels (4-6 FTE), and at recommended IP levels (7-8 FTE). RESULTS: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7-8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line-associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. CONCLUSIONS: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders

70. Impact of the Accelerate Pheno™ System on Clinical and Antimicrobial Outcomes among Inpatients with Gram-Negative Bacteremia at a 528-bed Community Teaching Hospital

Background Traditional methods in blood culture analysis require 24-72 hours to yield identification (ID) and antimicrobial susceptibility testing (AST) results, which may contribute to the use of empiric broad-spectrum antibiotic therapy. Hence, the primary objective of this study was to determine the impact of rapid blood culture analysis with the Accelerate Pheno™ system (AXDX) on time to antibiotic de-escalation. Methods This was a single center, case-control analysis of adult inpatients with E. coli or Klebsiella spp. bacteremia. Cases were prospectively identified by the antimicrobial stewardship team between August and October 2020 after the implementation of AXDX in July 2020. Subjects were matched to historical controls (July 2018-July 2020) based on age (± 3 years), gender, source of infection, and identified organism. The primary outcome was time to antibiotic de-escalation and time to oral antibiotic therapy from the time of positive blood cultures. Secondary outcomes included hospital length of stay, 30-day mortality, 30-day readmission, and 60-day C. difficile infection. Outcomes were compared using descriptive and inferential statistics. Results Of 33 cases identified, 30 (91%) were matched with historical controls. E. coli bloodstream infection was identified in 24 (80%) subjects while Klebsiella spp. was identified in 6 (20%) subjects. The average age was 66 years (SD ± 19) and there was an even distribution of males and females in both groups. Other demographics were similar between groups. The median time to species identification [14 hours (IQR 13 – 18) vs 34 hours (29 – 39), p\u3c 0.001) and AST [20 hours (19 – 37) vs 45 hours (38 – 51), p\u3c 0.001] from laboratory registration was significantly shorter in cases. The average time to antibiotic de-escalation was 1.7 (±1.2) days for cases compared to 2 (±1.3) days for controls (p=0.460). Median time to oral antibiotic therapy from positive blood cultures was 2.9 (1.8 – 4.7) days for cases and 3.4 (2.5 – 5.1) days for controls (p=0.166). There were no significant differences in the secondary outcomes. Conclusion AXDX did not appear to have a significant impact on time to antibiotic de-escalation and time to oral antibiotic therapy. However, time to organism ID and AST results were significantly shorter in the AXDX cohort